If the specialist anesthesiologist failed to intubate
patients in the Macintosh DL group after three trials, then the intubating laryngeal mask airway (LMA) was used to intubate
as an emergency precaution.
It should also have a high positive predictive value so that only a few patients with airways actually easy to intubate
are subjected to the protocol for management of a difficult airway.
A persistent "can't intubate
, can't oxygenate" crisis despite reversal of rocuronium with sugammadex.
Hospital policy usually dictates who on the hospital staff is allowed to intubate
. In fact, if an airway must be established, whichever individual is doing the intubating should go right ahead and intubate
over the TTOC.
In my opinion, an ideal intubation device should be versatile enough to aid in securing a definitive airway by both oral and nasal routes, especially in situations that result in failure to intubate
with direct laryngoscopy.
The court held, inter alia, that according to expert testimony by the plaintiff's board certified emergency physician, the defendants departed from accepted practice by failing to intubate
the patient and timely administer advanced life support medications, and added to it by the inappropriate administration of electrical defibrillation to an asystolic patient.
Every reasonable effort should be made to teach a resident to intubate
on a cadaver, taking the time needed to critique technique and allowing her to acquire the necessary skill and confidence.
The best environment in which to intubate
a patient is an operating room.
Dublin Coroner's Court heard evidence of two failed attempts to intubate
the infant in the minutes after his birth by Caesarean section at 1.30am.
The failure to successfully intubate
the trachea and secure the airway for patients remains a leading cause of morbidity and mortality in anesthesia practice.1-3 The absence of method that reliably predicts the existence of a difficult airway means that many difficult intubations are not known until induction of anesthesia.4,5 A wide variety of alternative airway devices and tools have been developed and, in part, successfully implemented in difficult airway management algorithms.6 Airtraq is a new intubation device that was initially designed to provide a view of the glottis without alignment of the oral, pharyngeal and tracheal axes and has developed to facilitate tracheal intubation in patients with normal airways.7
Laryngoscopy was performed 50 s after the administration of succinylcholine (Size 3 Macintosh blade), aiming to intubate
the trachea at 60 s.
However, the care team could intubate
under general anesthesia if the vocal cords were visible.